MEDICARE: MS. PATRICIA FLORA MIKKELSEN LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC33472	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8132	OTHER	CA	MH PSP
2	60081	OTHER	CA	ALCOHOL AND DRUG PSP

General Provider Information

NPI Number	:	1669673158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA FLORA MIKKELSEN LMFT

Provider Business Mailing Address
First Line	:	2577 SAN PABLO AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94612-1159
Country	:	US
Telephone Number	:	510-446-7107
Fax Number	:	510-832-0609

Provider Business Practice Location Address
First Line	:	2577 SAN PABLO AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94612-1159
Country	:	US
Telephone Number	:	510-446-7107
Fax Number	:	510-832-0609

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/08/2007

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